The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index; 19 of the 42 sources its claims cite were checked for support.
Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial
Open accessAbstract
Background Type 2 diabetes is a chronic disorder that requires lifelong treatment. We aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes. Methods We did this open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. Practices were randomly assigned (1:1), via a computer-generated list, to provide either a weight management programme (intervention) or best-practice care by guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (>5700 or ≤5700). Participants, carers, and research assistants who collected outcome data were aware of group allocation; however, allocation was concealed from the study statistician. We recruited individuals aged 20-65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27-45 kg/m 2 , and were not receiving insulin. The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825-853 kcal/day formula diet for 3-5 months), stepped food reintroduction (2-8 weeks), and structured support for long-term weight loss maintenance. Co-primary outcomes were weight loss of 15 kg or more, and remission of diabetes, defined as glycated haemoglobin (HbA 1c ) of less than 6·5% ( Findings Between July 25, 2014, and Aug 5, 2017, we recruited 306 individuals from 49 intervention (n=23) and contro…
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48 Own result · 33 Own method · 15 Own interpretation · 9 Partly supported · 8 No full text of the sources · 6 Couldn’t confirm · 3 Not checked yet · 3 No basis given · 2 Sources not found · 1 Supported · 1 Supported so far · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Other studies involving weight loss of at least 10-15 kg have been shown to achieve normalisations of blood glucose in people with short-duration type 2 diabetes, 7,8,9,10”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Introduction
What the sources say
- Not checked — no full text of the sourcecites [7] 7. Sjostrom L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014; 311: 2297-2304 source
- Not matchedcites [8] 8. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial -a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219- 10.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites [9] 9. Schauer PR, Burguera B, Ikramuddin S, et al.) Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003; 238: 467-484 source
The Results report a mean weight loss of 97 lb after gastric bypass—well above 10–15 kg—and say fasting glucose returned to normal in many patients. They also report that patients with a short duration of type 2 diabetes were more likely to achieve complete resolution. The source concerns surgical weight loss, not weight loss generally. (LLM, conf=0.87)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Baseline characteristics were similar between groups (Table 1).17”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
What the sources say
- Could not verifycites [17] 17. Finer S, Robb P, Cowan K, Daly A, Robertson E, Farmer A. Top ten research priorities for type 2 diabetes: results from the Diabetes UK-James Lind Alliance Priority Setting Partnership. Lancet Online First DOI:http://dx.doi.org/10.1016/S2213-8587(17)30324-8 accessed 13.11.2017 sourceExperimental — accuracy not yet measured
The section on the type 2 diabetes priority-setting process (page unavailable) describes survey respondents and how research questions were ranked, but does not compare baseline characteristics between groups. Searches for the quoted claim and for baseline characteristics or a Table 1 comparison found no supporting passage in our copy. (LLM, conf=0.76)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The essential mechanisms behind bariatric surgery are weight loss and decrease in body fat content, rather than any direct surgical effect.27,28,29,30,31”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Could not verifycites [27] 27. Talchai C, Xuan S, Lin HV, Sussel L, Accili D. Pancreatic beta cell dedifferentiation as a mechanism of diabetic beta cell failure. Cell 2012; 150: 1223-1234 sourceExperimental — accuracy not yet measured
The Results section discusses mouse models of β-cell dysfunction, and the Discussion addresses β-cell dedifferentiation under metabolic stress; neither addresses the mechanisms of bariatric surgery. Searches for bariatric surgery, weight loss, body-fat reduction, and direct surgical effects found no relevant passage in our copy. (LLM, conf=0.74)
- Not checked — no full text of the sourcecites [28] 28. Pinnick K, Neville M, Clark A, Fielding B. Reversibility of metabolic and morphological changes associated with chronic exposure of pancreatic islet beta-cells to fatty acids. J Cell Biochem 2010; 109: 683-692 source
- Partly supportedcites [29] 29. Lingvay I, Guth E, Islam A, Livingston E. Rapid improvement in Diabetes after Gastric Bypass Surgery. Diabetes Care 2013; 36:2741-2747 sourceExperimental — accuracy not yet measured
The Conclusions state that rapid diabetes improvement after Roux-en-Y gastric bypass is mediated by caloric restriction without invoking a primary direct hormonal effect of duodenal bypass. They also identify weight loss as a contributor to later diabetes remission. The paper does not establish decreased body fat as an essential mechanism or rule out all direct surgical effects of bariatric surgery. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“In a post-hoc analysis of the Look AHEAD dataset, a 10% weight loss in the first year, similar to that in the DiRECT, was associated with a 21% decrease in occurrence of cardiovascular outcomes over a median follow-up of 10•2 years.34”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Could not verifycites [34] 34. Arun CS, Pandit R, Taylor R. Long-term progression of retinopathy after initiation of insulin therapy in Type 2 diabetes: an observational study. Diabetologia 2004; 47: 1380-1384 sourceExperimental — accuracy not yet measured
The Subject characteristics section reports retinopathy outcomes over three and five years after insulin initiation, not cardiovascular outcomes after weight loss. Searches for Look AHEAD, DiRECT, 10% weight loss, the 21% decrease, and 10.2-year follow-up found no passage addressing the claim in our copy; page numbers were not available. (LLM, conf=0.78)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At 12 months, we recorded weight loss of 15 kg or more in 36 (24%) participants in the intervention group and no participants in the control group (p<0•0001).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Participants with missing primary outcome data were assumed not to have met the primary outcomes.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No serious adverse events led to withdrawal from the study.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fewer adverse events were reported during the food reintroduction and weight loss management phases than during the total diet replacement phase (appendix p10).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group (odds ratio 19•7, 95% CI 7•8-49•8; p<0•0001).”
- Also stated in: § Abstract · plain
“Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
plaincorrelationaln = 149- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Participants with missing primary outcome data were assumed not to have met the primary outcomes.
- Also stated in: § Abstract · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 139 participants who underwent total diet replacement, the most frequently reported adverse events, occurring over a mean duration of 16•0 weeks (SD 5•3), were constipation (n=65), increased sensitivity to cold (n=51), headache (n=53), and dizziness (n=49).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plainn = 139- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Just less than a quarter of participants in the intervention group achieved weight loss of 15 kg or more at 12 months, half maintained more than 10 kg loss, and almost half had remission of diabetes, off antidiabetic medication.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 51
- Probably not a substantial claim. 50
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“The weight changes seen at 12 months in the intention-to-treat population of the present study are similar to those reported in a Counterweight-Plus feasibility study (-9•5 kg in intention-to-treat analyses with baseline observation carried forward [n=91]) 12 and in an audit of its use in routine primary care, including patients with type 2 diabetes (-10•5 kg in intention-to-treat analyses with im”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Could not verifycites [12] 12. Doherty A, Jackson D, Hammerla N, Plötz T, et al. Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study. PLoS One 2017 12(2):e0169649 sourceExperimental — accuracy not yet measured
The Methods and Results passages describe seven-day accelerometer monitoring in UK Biobank, not a weight-loss intervention. Searches for Counterweight-Plus, 12-month weight change, and the primary-care audit found no passage in our copy addressing the attributed comparison. (LLM, conf=0.78)
- Not checked — no full text of the sourcecites [19] 19. Franz M, Vanwormer JJ, Crain L et al. Weight-loss Outcomes: A Systematic Review and Meta- Analysis of Weight-loss Clinical Trials with a Minimum 1 year follow up. J AmDietAssoc 2007;107:1755-1767. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Physical activity and sleep were objectively measured over 7 days by use of wristworn triaxial accelerometers; data were assessed with validated calibration and analysis algorithms.13,14”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Procedures
What the sources say
- Partly supportedcites [13] 13. van Hees VT, Sabia S, Anderson KN, et al. A Novel, Open Access Method to Assess Sleep Duration Using a Wrist-Worn Accelerometer. PLoS One.2015;10(11):e0142533. sourceExperimental — accuracy not yet measured
The Instrumentation section reports wrist-worn triaxial accelerometers, and Data Processing describes calibration methods and a sleep-analysis algorithm validated against polysomnography. But participants were asked to wear the devices for nine consecutive days, not seven; the paper also does not establish validation of a physical-activity analysis algorithm. (LLM, conf=0.86)
- Not matchedcites [14] 14. National Institute for Health and Care Excellence Type 2 diabetes in adults: management 2015 https://www.nice.org.uk/guidance/ng28 Accessed 30.10.2017
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Practices agreeing to participate were randomly assigned (1:1) by the Robertson Centre for Biostatistics (University of Glasgow, UK), via a computer-generated list, to provide either an evidence-based weight management programme (Counterweight-Plus; intervention) 12 or best-practice care by guidelines (control).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Randomisation and masking
What the sources say
- Could not verifycites [12] 12. Doherty A, Jackson D, Hammerla N, Plötz T, et al. Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study. PLoS One 2017 12(2):e0169649 sourceExperimental — accuracy not yet measured
The Methods (Study Population; page unavailable) describe randomly selecting UK Biobank participants’ email addresses for accelerometer invitations, not randomly assigning practices to trial arms. Searches for the Robertson Centre and Counterweight-Plus found no passage addressing the claimed 1:1 allocation or weight-management intervention. (LLM, conf=0.78)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Type 2 diabetes is strongly related to weight gain in adult life and accumulation of excess fat within the liver and pancreas.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Introduction
What the sources say
- Partly supportedcites [4] 4. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011; 54: 2506-2514 sourceExperimental — accuracy not yet measured
The Discussion (page not provided) links type 2 diabetes to excess lipid accumulation in the liver and pancreas, describing this as a hypothesis consistent with the study’s findings. The paper does not establish the separate claim that type 2 diabetes is strongly related to weight gain in adult life; it studied weight loss after diagnosis, not adult-life weight gain. (LLM, conf=0.85)
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For participants who ceased to engage and did not attend their 12 month trial appointment, data from GP records (within a window of plus or minus 3 months of the scheduled follow-up date) were used if available, as pre-specified in the protocol.11”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Outcomes
What the sources say
- Partly supportedcites [11] 11. Lean M, Brosnahan N, McLoone P, et al. Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity. Br J Gen Pract 2013; 63: e115-124 sourceExperimental — accuracy not yet measured
The Outcome evaluations for analysis section says 12-month weights were taken within ±90 days of 365 days from baseline, and that weights for patients lost to follow-up were obtained opportunistically from health-professional measurements outside the study. It does not specify GP records, a missed trial appointment, or that this approach was pre-specified in a protocol. (LLM, conf=0.85)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Look AHEAD 21 delivered a heavily supported programme in specialist centres, combining physical activity and dietary programme, and achieved a mean weight loss of 8•6 kg.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Partly supportedcites [21] 21. Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA : the journal of the American Medical Association. 2012;308(23):2489-96 sourceExperimental — accuracy not yet measured
The Study Design and Intervention sections describe 16 US research centers and frequent counseling combining dietary changes with increased physical activity. The Results report mean first-year weight loss of 8.6%, not 8.6 kg; the claimed unit is unsupported. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The twin cycle hypothesis, 4 which postulated that type 2 diabetes is caused specifically by excess fat within the liver and pancreas, was tested by inducing negative energy balance with a 600-700 kcal/day diet.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Introduction
What the sources say
- Supportedcites [4] 4. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011; 54: 2506-2514 source
The Discussion describes a hypothesis that excess lipid accumulation in the liver and pancreas is the common cause of the defects underlying type 2 diabetes, and says the study’s findings are consistent with it. The Methods (Experimental protocol; page not provided) report testing participants with a diet of about 600 kcal/day, within the stated 600–700 kcal/day range. (LLM, conf=0.92)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“28% of all eligible individuals volunteered to participate, 17 and 79% completed the intensive total diet replacement phase”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Could not verifycites [17] 17. Finer S, Robb P, Cowan K, Daly A, Robertson E, Farmer A. Top ten research priorities for type 2 diabetes: results from the Diabetes UK-James Lind Alliance Priority Setting Partnership. Lancet Online First DOI:http://dx.doi.org/10.1016/S2213-8587(17)30324-8 accessed 13.11.2017 sourceExperimental — accuracy not yet measured
The citation follows the 28% participation figure. The paper’s section on the priority-setting process reports responses to a research-priorities questionnaire, not the proportion of eligible individuals who volunteered for a diet-replacement intervention. Searches for the 28% figure and the total diet replacement phase found no supporting passage in our copy; no page number is available. (LLM, conf=0.77)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Bariatric surgery has dominated discussions of type 2 diabetes remission as the most effective way of producing major weight loss.8,9,10”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not matchedcites [8] 8. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial -a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219- 10.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites [9] 9. Schauer PR, Burguera B, Ikramuddin S, et al.) Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003; 238: 467-484 source
The Conclusion explicitly calls bariatric surgery the most effective current weight-loss treatment and links it to improved glycemic control in patients with type 2 diabetes. The Discussion also reviews diabetes resolution after several bariatric procedures, supporting the sentence’s broader framing. (LLM, conf=0.88)
- Partly supportedcites [10] 10. Leslie WS, Ford I, Sattar N, et al. The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial. BMC Fam Pract 2016; 17: 20 sourceExperimental — accuracy not yet measured
The Background and Discussion describe bariatric surgery as a way to achieve substantial weight loss and type 2 diabetes remission, and note that guidelines recommend it for obese patients with type 2 diabetes. They do not say it dominated discussions of remission or establish it as the most effective way to produce major weight loss; the paper also describes substantial weight loss through non-surgical diets. The indexed passages provide section labels but no page numbers. (LLM, conf=0.84)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The sample had characteristics very similar to the general population of people with type 2 diabetes, so the results are likely to be generalisable.17”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Partly supportedcites [17] 17. Finer S, Robb P, Cowan K, Daly A, Robertson E, Farmer A. Top ten research priorities for type 2 diabetes: results from the Diabetes UK-James Lind Alliance Priority Setting Partnership. Lancet Online First DOI:http://dx.doi.org/10.1016/S2213-8587(17)30324-8 accessed 13.11.2017 sourceExperimental — accuracy not yet measured
The paper’s section on the Priority Setting Partnership (page unavailable) reports broad reach among key target groups and expresses confidence that the process captured key research priorities. It does not compare respondents’ characteristics with those of the general population of people with type 2 diabetes, so the stated basis for generalisability is unsupported. (LLM, conf=0.76)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Sudden restoration of normoglycaemia can precipitate worsening of diabetic retinopathy, although this outcome is rare when early or no retinopathy is present.35”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Could not verifycites [35] 35. McCombie L, Leslie W, Taylor R, Kennon B, Sattar N, Lean MEJ. Beating type 2 diabetes into remission. BMJ 2017 358:j4030 https://doi.org/10.1136/bmj.j4030 accessed 13.11.2017 Age (years) 55•9 (7•3) 52•9 (7•6) Weight (kg) 98•8 (16•1) 101•0 (16•7) BMI (kg/•3) •5) Waist (cm) 106•9) 107•4) Systolic BP (mmHg) 137•2 (16•0) 132• sourceExperimental — accuracy not yet measured
The 'Potential metabolic value of remission' section (p. 2) says good glycaemic control improves microvascular outcomes, including retinopathy, but does not address transient worsening after sudden restoration of normoglycaemia. Searches for rapid glucose improvement and early retinopathy found no passage addressing the claimed risk or its rarity. (LLM, conf=0.72)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The benefits to individuals 32 and the improved physical and psychological wellbeing accompanying substantial weight loss have previously been documented.33”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Partly supportedcites [32] 32. Rehackova L, Araujo-Soares V, Adamson AJ, Stevens S, Taylor R, Sniehotta FF. Acceptability of a Very Low Energy Diet in Type 2 Diabetes: Patient Experiences and Behaviour Regulation. Diabetic Med 2017; 34:1554-1567 sourceExperimental — accuracy not yet measured
The Changing management section (p. 1) links substantial weight loss in people with type 2 diabetes to longer life expectancy and remission, and says remission brings personal achievement and empowerment. These support physical and psychological benefits in that setting, but the paper does not document improved wellbeing from substantial weight loss for individuals generally. (LLM, conf=0.82)
- Not matchedcites [33] 33. The LookAHEAD Research Group. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. The Lancet Diabetes & Endocrinology 2016, 4: 913-921
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Even if diabetes recurs, there might be a legacy effect of a period of good glucose control, as suggested in the UK Prospective Diabetes Study.35”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Partly supportedcites [35] 35. McCombie L, Leslie W, Taylor R, Kennon B, Sattar N, Lean MEJ. Beating type 2 diabetes into remission. BMJ 2017 358:j4030 https://doi.org/10.1136/bmj.j4030 accessed 13.11.2017 Age (years) 55•9 (7•3) 52•9 (7•6) Weight (kg) 98•8 (16•1) 101•0 (16•7) BMI (kg/•3) •5) Waist (cm) 106•9) 107•4) Systolic BP (mmHg) 137•2 (16•0) 132• sourceExperimental — accuracy not yet measured
The ‘Potential metabolic value of remission’ section (p. 2) says good glycaemic control improves microvascular outcomes and notes that remission can decline over time. It does not say that benefits persist after diabetes recurs or attribute a legacy effect to the UK Prospective Diabetes Study. (LLM, conf=0.82)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Remission was closely related to the degree of weight loss maintained at 12 months, with achievement in 86% of participants with at least 15 kg weight loss, and 73% of those with weight loss of 10 kg or more.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
plainconditionalSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most of these adverse events were of mild or moderate severity and dissipated over time (appendix p10).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plainn = 139- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Remission varied with weight loss in the whole study population, with achievement in none of 76 participants who gained weight, six (7%) of 89 participants who maintained 0-5 kg weight loss, 19 (34%) of 56 participants with 5-10 kg loss, 16 (57%) of 28 participants with 10-15 kg loss, and 31 (86%) of 36 participants who lost 15 kg or more.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
plaincorrelationaln = 306- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mean bodyweight fell by 10•0 kg (SD 8•0) in the intervention group and 1•0 kg (3•7) in the control group (adjusted difference -8•8 kg, 95% CI -10•3 to -7•3; p<0•0001).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
plainn = 149 ·- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- The authors state this as an assumption: Participants with missing primary outcome data were assumed not to have met the primary outcomes.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes remission (HbA1c <48mmol/mol, off diabetic medication of ≥2 months) Intervention 65/127 (b) (51•2%) 23•8 (9•60, 58•8) p<0•0001 Control 6/147 (4•1%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plaincorrelationalSingle case ·- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“HbA1c <42mmol/mol Intervention 40/138 (29•0%) 8•38 (3•49, 20•14) p<0•0001 Control 7/148 (4•7%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plaincorrelationalSingle case ·- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similar patterns were recorded for BMI and weight change as a percentage of baseline weight (appendix p2).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients who completed the total diet replacement phase had greater weight loss, and those who completed the food reintroduction phase less weight gain, than did patients who started, but did not complete, each phase (figure 3, appendix p4).”
- Also stated in: § Imputation options: · plain
“Change during TDR Mean (SD) [95% CI] -14•5 (6•0) [-15•5, -13•4] -3•0 (3•6) [-5•0, -1•0] -11•5 (-14•5, -8•6), p<0•0001”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § Imputation options: · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Constipation 65 (46•8) 30 (21•6) 24 (17•3) 11 (7•9) 18 (14•5) 14 (11•3) 4 (3•2) 0 (0•0) 6 (6•4) 2 (2•1) 2 (2•1) 2 (2•1)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainn = 139- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Number of other prescribed medications (not oral antidiabetic or antihypertensive) Intervention 148 3•5 (3•0) 4•0 (3•9) 0•5 (2•0) -0•08 (-0•49, 0•33) p=0•7036 (b) <0•01 Control 148 3•6 (3•4) 4•2 (3•7) 0•6 (1•4)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainSingle case- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Four participants in the intervention group who had diabetes remission had received a short rescue plan in the total diet replacement phase because of weight regain within 60 days of their 12 month assessment.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plainn = 4- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This approach resulted in 68% of the intervention group remaining off antihypertensive drugs at 12 months, with no increase in mean blood pressure.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“HDL-cholesterol (mmol/l) Intervention 121 1•1 (0•3) 1•2 (0•4) 0•13 (0•25) 1•06 (1•00, 1•13) p=0•0563 0•15 Control 147 1•2 (0•3) 1•2 (0•3) 0•04 (0•21)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainn = 15 ·- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diastolic blood pressure (mmHg) Intervention 128 84•8 (10•2) 83•5 (9•5) -1•3 (10•3) -0•4 (-2•5, 1•6) p=0•6863 <0•01 Control 147 85•5 (8•8) 84•5 (8•9) -1•1 (10•1)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Total cholesterol (mmol/l) Intervention 121 4•3 (1•1) 4•5 (1•3) 0•23 (1•36) 1•03 (0•97, 1•10) p=0•2874 0•05 Control 147 4•3 (1•1) 4•3 (1•1) 0•07 (0•87)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainn = 5- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Control (n=115) Intervention (143) Reason for withdrawal 0 26 (0) No remission; patient decision 0 1 (3.8%)Medical reasons 0 2 (7.7%)Social reasons 0 8 (30.8%)Limited weight loss 0 3 (11.5%)Weight regain 0 1 (3.8%)Other 0 6 (23.1%)Not Known 0 5 (19.2%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plainn = 26- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The programme allowed almost half of participants to revert to a non-diabetic state, off antidiabetic drugs at 12 months, and 68% stopped antihypertensive medications with no rise in blood pressure.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We recorded diabetes remission in 68 (46%) participants in the intervention group and six (4%) participants in the control group (odds ratio 19•7, 95% CI 7•8-49•8; p<0•0001, Fig 2).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“BMI (kg/m 2 ) Intervention 137 35•0 (4•5) 31•5 (4.9) -3•5 (2.8) -3•0 (-3•5, -2•5) p<0•0001 0•01 Control 148 34•2 (4•3) 33•8 (4•5) -0•4 (1.3)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainSingle case ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients who completed the total diet replacement phase had greater weight loss, and those who completed the food reintroduction phase less weight gain, than did patients who started, but did not complete, each phase (figure 3, appendix p4).”
- Also stated in: § Imputation options: · plain
“Change during FR Mean (SD) [95% CI] 1•0 (3•2) [0•3, 1•6] 3•2 (2•3) [2•1, 4•3] -2•7 (-4•3, -1.1), p=0•0010”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- Also stated in: § Imputation options: · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“12 Months Mean (SD) 87•0 (15•1) 92•0 (17•2) -5•0 (-11•6, 1•7), p=0•1424”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In terms of lipids, although only triglyceride concentrations declined, baseline cholesterol values were suppressed under guidelinedriven statin prescriptions.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two of the 12 participants who received rescue plans within 60 days of their 12 month assessment achieved more than 15 kg weight loss.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plainn = 12- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Mean bodyweight fell by 10•0 kg in the intervention group and by 1•0 kg in the control group (adjusted difference at -8•8 kg, 95% CI -10•3 to -7•3; p<0•0001; Table 2).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All Patients HbA1c <48mmol/mol Intervention 71/138 (48•6%) 7•02 (3•66, 13•46) p<0•0001 Control 23/148 (15•5%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plaincorrelationalSingle case ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Change during WLM Mean (SD) [95% CI] 1•9 (2•9) [1•2, 2•5] 2•4 (3•0) [1•3, 3•5] -0•6 (-1•8, 0•7), p=0•3809”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Control 91/148 (61.5%)Prescribed antidepressants Intervention 40/148 (27.0%) 1.40 (0.79, 2.49) p=0.2506”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Percentage weight change from baseline (a) Intervention 137 -9•9 (7•6) -8•8 (-10•2, -7•3) p<0•0001 0•01 Control 148 -1•1 (3•8)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plainSingle case ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The planned primary analyses were done at the individual level, according to the intention-to-treat principle.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Liver insulin resistance and fat content normalised within 7 days, with first-phase insulin response and pancreas fat content normalising over 8 weeks.5”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Introduction
What the sources say
- Not matchedcites [5] 5. Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very Low Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders. Diabetes Care 2016; 39: 158-165
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Information about symptoms was collected only from participants in the intervention group.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All models were adjusted for the minimisation variables (study centre and practice list size).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The large numbers of people with type 2 diabetes makes it impossible to offer surgery to all people, even if this approach were financially possible and palatable to everyone.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“However, this option comes at a high financial cost and with the risk of long-term problems, such as post-prandial hypoglycaemia, and micronutrient deficiencies that restrict acceptability.25,26”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not matchedcites [25] 25. Vecht J, Masclee AA, Lamers CB. The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment. Scand J Gastroenterol Suppl 1997; 223: 21-27
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [26] 26. White MG, Shaw JAM, Taylor R. Type 2 diabetes: The pathologic basis of reversible beta-cell dysfunction. Diabetes Care 2016; 39: 2080-2088 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Outcomes were compared between groups with mixed-effects regression models, with adjustment for GP practice as a random effect.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The Counterbalance study 6 reported similar weight loss, but was intensively managed with very low calorie diet in a research centre.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Henry RR, Schaeffer L, Olefsky JM. Glycaemic effects of intensive caloric restriction and isocaloric refeeding in non-insulin dependent diabetes mellitus. Journal of Clinical Endocrinology and Metabolism 1985; 61: 917-925 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“More than 25 years ago, Wing and colleagues 24 reported improvement of HbA1c, from a higher baseline level than DiRECT, after a very low calorie diet intervention under specialist supervision, with mean weight loss at 12 months of 8•6 kg.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not checked — no full text of the sourcecites [24] 24. Meier JJ, Butler AE, Galasso R, Butler PC. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Diabetes Care 2006; 29: 1554-1559 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“23 (8%) participants were lost to follow-up at 12 months, with 128 (86%) participants in the intervention group and 147 (99%) participants in the control group attending the 12 month study assessment.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plainn = 23- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A nurse or dietitian (as available locally) in each intervention practice was given a total of 8 h structured training by the study research dietitians experienced in Counterweight-Plus.Training followed a standard protocol, to minimise variability and maintain fidelity across all practices.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Procedures
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, data for the first primary outcome (weight loss ≥15kg) were available for 285 (96%) participants (n=137 intervention and n=148 control), and for the second primary outcome (diabetes remission) for 290 (97%) participants (n=142 and n=148, respectively).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plainn = 137- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Randomisation was stratified to maintain balance for practice list size (>5700 or ≤5700) across intervention groups within each study region.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Randomisation and masking
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Antihypertensive drugs were withdrawn because blood pressure rapidly decreases upon commencement of a low energy diet.6”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Procedures
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Henry RR, Schaeffer L, Olefsky JM. Glycaemic effects of intensive caloric restriction and isocaloric refeeding in non-insulin dependent diabetes mellitus. Journal of Clinical Endocrinology and Metabolism 1985; 61: 917-925 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sample-size calculations indicated that recruitment of 280 participants would be required to achieve 80% power.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Statistical analysis
hedgedn = 280- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In the intervention group, six (4%) participants consented, but thereafter never engaged with the intervention, and 26 (17%) participants withdrew from treatment during the first 12 months (n=15 during total diet replacement, n=6 during stepped food reintroduction, and n=5 during weight loss maintenance).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
plainn = 6- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Remission of type 2 diabetes was not the primary outcome in Look AHEAD, but was observed in 11•5% of participants after 1 year and 7•5% after 4 years, with 9•2% achieving remission for at least 2 years.22”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not checked — no full text of the sourcecites [22] 22. Uusitupa MIJ. Early Lifestyle Intervention in Patients with Non-insulin-dependent Diabetes Mellitus and Impaire Glucose Tolerance. Annals of Med 28: 445-449; 2006 http://dx.doi.org/10.3109/07853899608999106 accessed 13.11.201 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The co-primary outcomes were analysed in a hierarchical manner, the weight loss outcome first, with no adjustment of the p values for multiple comparisons.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Role of the funding source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Models of continuous outcomes were also adjusted for the baseline measurement of the outcome.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Findings from Franz and colleagues' meta-analysis 20 showed an average weight change of about 10 kg at 12 months from interventions with very low calorie diets.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not matchedcites [20] 20. LookAhead Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity 2014; 22: 5-13
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“A Finnish study 23 showed improved glucose control and reduced use of diabetes medication after years 1 and 2 of a lifestyle intervention.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not checked — no full text of the sourcecites [23] 23. Wing RR, Marcus MD, Salata R, Epstein LH, Miaskiewicz S, Blair EH. Effects of a very-low- calorie diet on long-term glycemic control in obese type 2 diabetic subjects. Arch Intern Med. 1991;151(7):1334-40. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the nature of the lifestyle intervention being examined, participants, carers, and research assistants who collected outcome data were aware of group allocation; however, allocation was concealed from the study statistician in charge of developing and conducting the statistical analysis programme (AM).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Randomisation and masking
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The primary care practice was the unit of randomisation to enable consistent management of type 2 diabetes within practices and avoid contamination between treatment groups.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Randomisation and masking
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the nature of the lifestyle intervention being examined, participants, carers, and research assistants who collected outcome data were aware of group allocation; however, allocation was concealed from the study statistician in charge of developing and conducting the statistical analysis programme (AM).”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Randomisation and masking
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The strengths of the study include a well-defined evidence-based intervention and a robust cluster-randomised study design, managed by a well-established clinical trials unit.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Intervention effects reported as estimated odds ratios (Intervention:Control), based on mixed effects logistic regression model, adjusted for randomised group, study centre (Tyneside, Scotland), and practice list size (≤5700, >5700) as fixed effects, and GP practice as a random effect.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“There were limitations to the data that could be collected in the routine primary care setting; therefore, detailed body composition was not assessed.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data for physical activity should be viewed with caution because they were based on around half of all participants in each group for whom the data were complete.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We did collect information about serious adverse events in both groups, retrospectively at the 12 month assessments, and recorded only two, in the same participant, that might have been related to the intervention.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
hedgedconditionalSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is not possible to exclude some contamination of the control group, with deliberate weight loss as a result of media publicity about the intervention during the study.Such contamination would have tended to attenuate the effects of the intervention.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Intervention effects reported as estimated mean differences (Intervention-Control), based on mixed effects linear regression model, adjusted for randomised group, baseline value (a) , study centre (Tyneside, Scotland), and practice list size (≤5700, >5700) as fixed effects, and GP practice as a random effect.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Weight loss leads to a rapid and marked fall in blood pressure, with risk of postural hypotension if antihypertensive drugs are continued.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Henry RR, Schaeffer L, Olefsky JM. Glycaemic effects of intensive caloric restriction and isocaloric refeeding in non-insulin dependent diabetes mellitus. Journal of Clinical Endocrinology and Metabolism 1985; 61: 917-925 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The dropout rate of 25% in the intervention group was an indication of non-acceptability for this proportion, but should be considered in relation to the overall effectiveness of the programme for a much greater proportion.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study was funded as a Strategic Research Initiative by Diabetes UK (award number 13/0004691).The formula diet was donated by Cambridge Weight Plan.Neither organisation had any input into the study design, data analysis or interpretation.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Acknowledgements
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The study design stipulated data collection from the control group only at baseline and 12 months, so intercurrent adverse events could not be assessed.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Antidiabetic medications were stopped in the intervention group, but not in the control group.Withdrawal of antidiabetic medications might have been possible in some participants in the control group, but the study design was a comparison of the entire programme with current standard of care, under current guidelines.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The racial and ethnic characteristics, while typical of the populations of Scotland and Tyneside, do not allow for unqualified extrapolation to other groups, such as south Asians, who tend to develop diabetes with less weight gain.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Differences in the change during each phase derived from a linear regression model of the change in weight, adjusted for weight at the start of the phase”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The present study was not designed or powered to evaluate effects on complications of diabetes.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The sample size exceeded the need for statistical power, and the remission rate of 46% greatly exceeded the level of 22% considered clinically important.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because the unit of randomisation was the primary care centre, participants were aware of their planned allocation to the control or intervention group; however, negligible bias seemed to result from this design on the basis of baseline group characteristics.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We cannot exclude a carryover acute effect of the rescue plans suppressing HbA1c in these participants, but believe any such effect would have been very small and unlikely to affect the study conclusions.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
hedgedconditionaln = 4- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The conclusions reported here apply to people with type 2 diabetes diagnosed within the previous 6 years, and existing evidence has shown that remission is less likely with longer durations of disease.6,8”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Discussion
What the sources say
- Not checked — no full text of the sourcecites [6] 6. Henry RR, Schaeffer L, Olefsky JM. Glycaemic effects of intensive caloric restriction and isocaloric refeeding in non-insulin dependent diabetes mellitus. Journal of Clinical Endocrinology and Metabolism 1985; 61: 917-925 source
- Not matchedcites [8] 8. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial -a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219- 10.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For per protocol analyses, no assumptions were made about missing values.”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given that few in the control group achieved this outcome, the planned analyses using logistic regression models with interaction terms were highly underpowered, so the odds ratios presented here relate to achievement of the outcome in the Intervention group only, for each subgroup relative to the reference group”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
No previous trial based on dietary change has assessed sustained (≥1 year) disease remission as a primary outcome.
“but no previous trial based on dietary change has assessed sustained (ie, ≥1 year) disease remission as a primary outcome.”
The paper relies on this without support.
No previous registered study has set remission of type 2 diabetes as a primary outcome.
“Furthermore, no previous registered study has set remission of type 2 diabetes as a primary outcome.”
The authors state this as an assumption.
Participants with missing primary outcome data were assumed not to have met the primary outcomes.
“For participants who did not attend the 12 month study assessment, and for whom data could not be obtained from GP records, we made the assumption that the primary outcomes were not met.”
The paper relies on this without support.
The challenge remained to test whether such an intervention was practicable in routine primary care.
“The challenge remained to test whether such an intervention was practicable in routine primary care.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source doesn’t support the claim as written.
In the citing paper
“A systematic review and meta-analysis of 10 RCTs assessing lifestyle interventions vs standard care in persons with T2D found a pooled effect of 3.33 kg average weight loss associated with a 0.29% decline in A1C.687”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [687]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe cited source doesn’t support the claim as written.
In the citing paper
“In a trial of 7447 participants in Spain at high cardiovascular risk (50% with diabetes), the 5-year absolute risk of the cardiovascular primary end point (myocardial infarction, stroke, or death from cardiovascular causes) was 3.8% (95% CI, 3.2%–4.4%) in the group randomized to receive a Mediterranean diet combined with extra virgin olive oil or nuts vs 5.7% (95% CI, 4.6%–6.9%) in the control”
From Diagnosis and Treatment of Type 2 Diabetes in Adults (2025) · cites this paper as [28]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The most important feature for diet modification is a reduced-calorie meal plan, which is essential for effective weight loss.687–690”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [687]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In DiRECT, a randomised controlled effectiveness trial, weight management intervention after 2 years resulted in mean weight loss of 7·6 kg”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Of 36 in the intervention group who maintained over 10 kg weight loss at 2 years, 29 (81%) were in remission.”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [2]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“with 36% of participants in remission of type 2 diabetes.”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“At both month 12 and 24, over 80% of participants maintaining a weight loss of more than 15 kg , and 75% of those who maintained over 10 kg weight loss, were in remission of type 2 diabetes. 2-4”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Remission effect-sizes at years 1 and 2, 2,3 also shown in the DIADEM-1, 45 and in the STANDby 46 randomised trials, with almost identical weight management interventions, are large and consistent”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Lifestyle interventions (including diet, exercise and behavioural changes) are the cornerstone of obesity management with diverse benefits, but even the most intensive lifestyle interventions result in up to 10% mean weight loss (WL) and weight maintenance remains a challenge, as 80% of WL is expected to be regained over the next 5 years [4, 5].”
From What is the pipeline for future medications for obesity? (2025) · cites this paper as [5]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Sustained weight loss of a similar magnitude to that observed in this trial has been linked to improvements in obesityrelated complications, [25][26][27] such as type 2 diabetes, 28 with treatment guidelines recommending sustained weight loss of 5% to 15% for people with these conditions.5,6”
From Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial (2021) · cites this paper as [27]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Evidence has consistently demonstrated their benefits in individuals with obesity, including substantial WL (often exceeding the 10% WL achieved with intensive lifestyle interventions), improved quality of life (QoL), and reductions in obesity-related organ damage [7,8].”
From Nutrition and Physical Activity in Optimizing Weight Loss and Lean Mass Preservation in the Incretin-Based Medications Era: A Narrative Review (2025) · cites this paper as [7]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Studies have demonstrated that a variety of eating plans, varying in macronutrient composition, can be used effectively and safely in the short term (1-2 years) to achieve weight loss in people with diabetes.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [106]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“For example, lifestyle interventions can lead to remission of early T2D and prediabetes61.”
From A systematic review and meta-analysis of the efficacy and safety of pharmacological treatments for obesity in adults (2025) · cites this paper as [61]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“a VLCD with meal replacement is effective for achieving diabetes remission in individuals with obesity lasting for at least 2 years”
From Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance (2021) · cites this paper as [18]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Many studies have shown that T2DM can be slowed down, stopped, or even reversed by changing lifestyle (eg, low-calorie diet and increasing physical activity) [11,12].”
From Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis (2025) · cites this paper as [11]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The UK DiRECT study, as well as the DiRECT-Aus trial provide evidence that remission is possible with sustained weight loss maintenance, with 68 out of 138 people, and 86 out of 155 people in the intervention group achieving remission at 12 months in each respective cohort31,37.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [31]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The longer the time since first diagnosis of T2D, the more difficult it may be to reverse the impacts of T2D, as reported in the DiRECT trial.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [31]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Three non-pharmaceutical approaches have demonstrated high rates of at least temporary T2D diabetes reversal or remission: bariatric surgery, very low calorie diets (VLCD), and nutritional ketosis achieved through carbohydrate restriction (8–10).”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [9]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This approach is necessarily temporary, however, with weight regain and impaired glucose control typically occurring within 3–6 months of reintroduction of substantial proportions of dietary carbohydrates (9, 18–20).”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [9]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“VLCDs providing <900 kcal/day allow rapid discontinuation of most medications, improved glycemic control, and weight loss.”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [9]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“weight loss targeted at $ 15%, when such can feasibly and safely be accomplished, is associated with even better outcomes in type 2 diabetes (138,141).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [138]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Remission rates were related to magnitude of weight loss, rising progressively from 7% to 86% as weight loss at 1 year increased from , 5% to $ 15% (138).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [138]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Recent interventions with intensive diet and exercise, newer pharmacological agents (e.g., glucagon-like peptide 1 receptor agonists), or surgical weight loss have led to diabetes remission (86 -92)”
From 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024 (2024) · cites this paper as [86]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Since this degree of sustained weight loss is not commonly achieved by lifestyle interventions alone,687,688”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [687]
The cited source says what the claim attributes to it.
In the citing paper
“The Diabetes Remission Clinical Trial (DiRECT) found that 46% of people who had type 2 diabetes with less than 6 years' duration and were not on insulin, reach remission at 12 months, defined as HbA1c below 48 mmol/mol (6·5%) without medication, using a structured weight management programme.”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“In the whole study population, remission directly varied with degree of weight loss (88).”
The cited source says what the claim attributes to it.
In the citing paper
“The Diabetes Remission Clinical Trial (DiRECT) demonstrated greater remission of diabetes with a weight management program than with usual best practice care in adults with type 2 diabetes within 6 years of diagnosis.”
The cited source says what the claim attributes to it.
In the citing paper
“Structured weight loss programs with regular visits and use of meal replacements have been shown to enhance weight loss in people with diabetes (138 -140).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [138]
The cited source says what the claim attributes to it.
In the citing paper
“The DiRECT trial showed that at 1 year, weight loss associated with the lifestyle intervention resulted in diabetes remission in 46% of participants (138).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [138]
The cited source says what the claim attributes to it.
In the citing paper
“Several studies have now shown that weight loss of at least 10-15 kg frequently normalises blood glucose in people with short-duration type 2 diabetes, and DiRECT did this in a real-life primary care setting. 9-12”
The cited source says what the claim attributes to it.
In the citing paper
“Diet management programs, including the use of low-calorie mealreplacement products, can sustain low-calorie diet-induced weight loss with a small weight regain. 11,15-17”
From Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined (2021) · cites this paper as [15]
The cited source says what the claim attributes to it.
In the citing paper
“This is more than the total weight losses of approximately 10% that were obtained with 1-year diet-management programs after an initial low-calorie diet. 11,15,16,29”
From Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined (2021) · cites this paper as [15]
The cited source says what the claim attributes to it.
In the citing paper
“Length of time with a T2D diagnosis is a factor in remission, with longer time since diagnosis resulting in lower remission (4, 5, 9).”
The cited source says what the claim attributes to it.
In the citing paper
“Previous studies consistently report that weight loss increases the likelihood of T2D remission (4, 5, 9).”
The cited source says what the claim attributes to it.
In the citing paper
“Bariatric surgery has dominated discussions of type 2 diabetes remission as an effective way of producing major weight loss and diabetes remissions. 10-12”
The cited source says what the claim attributes to it.
In the citing paper
“The Look AHEAD trial (177) and the DiabetesRemissionClinicalTrial(DiRECT) (138) highlight the potential for type 2 diabetes remission d defi ned as the maintenance of euglycemia (complete remission) or prediabetes level of glycemia (partial remission) with no diabetes medication for at least 1 year (177,178) d in people undergoing weight loss treatment.”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [138]
The cited source says what the claim attributes to it.
In the citing paper
“However, more recent data from the Look Ahead (Wing 2013) and DiRECT (Lean 2018) studies suggest that significant improvements in glycaemic control, as well as sustained weight loss can be achieved in people with T2D with intensive lifestyle interventions and total dietary replacement.”
From Mindfulness-based interventions for adults with type 2 diabetes mellitus (2021) · cites this paper as Lean 2018
The cited source says what the claim attributes to it.
In the citing paper
“These trial designs align with routine clinical practice, such as primary care and commercial weight management services [32, 33], but offer limited insight into how best to integrate nutritional care with pharmacotherapy.”
From Nutrition Strategies for Next‐Generation Incretin Therapies: A Systematic Scoping Review of the Current Evidence (2026) · cites this paper as [32]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“This may explain why the females in the cohort had lesser reductions in HbA1c when compared to males31.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [31]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Weight loss may not be the goal for some patients, and many people are actively seeking to reduce the number of medications that they take.”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [65]
Experimental — accuracy not yet measuredIn the citing paper
“Given the modest efficacy of currently approved pharmacotherapies, [7][8][9] semaglutide may offer the potential to bridge the gap between behavioral and pharmacological options and bariatric surgery, which is currently considered the most effective and reliable intervention available for weight management.6,27,32”
In the citing paper
“Five studies compared diet interventions with usual care according to clinical guidelines, without providing foods or dietary products for participants [49–53].”
In the citing paper
“These two RCTs were designed with remission as the primary outcome [51, 53].”
In the citing paper
“Compared with remissions of 4–12% in well-matched usual care control arms, the interventions generated median 54% remission at 12 months from baseline (N = 445, two RCTs; GRADE high certainty of evidence), with diabetes durations <6 or <2 years, and mean weight loss of 10 and 12 kg.”
In the citing paper
“Only two RCTs had remission as the pre-specified outcome, both relatively large and using almost identical designs and diets, with very similar results, but in very different populations, notably with different durations of diabetes [51, 53, 89].”
In the citing paper
“At 12 months, almost half of the participants in the intervention group achieved remission to a non-diabetic state and were off glucoselowering drugs.61”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [61]
In the citing paper
“Long-term weight loss in people living with obesity can reduce the risk and progression of noncommunicable diseases.”
From Long-term Weight Loss in a Primary Care-Anchored eHealth Lifestyle Coaching Program: Randomized Controlled Trial (2022) · cites this paper as [2]
In the citing paper
“Numerous studies have shown that type 2 diabetes (T2D) can be slowed, halted, or even reversed through lifestyle changes, such as a low-calorie diet and increased physical activity [2,3].”
From Long-term Weight Loss in a Primary Care-Anchored eHealth Lifestyle Coaching Program: Randomized Controlled Trial (2022) · cites this paper as [2]
In the citing paper
“Incretin-based medications have transformed obesity management by enabling substantial body weight reduction.”
From Nutrition and Physical Activity in Optimizing Weight Loss and Lean Mass Preservation in the Incretin-Based Medications Era: A Narrative Review (2025) · cites this paper as [7]
In the citing paper
“The use of more prescriptive meal plans such as meal replacements, especially during the first few months of treatment, has been shown to have a positive benefit in terms of weight reduction in patients with T2DM”
From Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions (2025) · cites this paper as [109]
In the citing paper
“Structured weight loss programs with regular visits have been shown to enhance weight loss in T2DM [121,122,123].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [121]
In the citing paper
“The DiRECT trial showed that at 1 year, weight loss associated with the lifestyle intervention resulted in diabetes remission in 46% of participants [121].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [121]
In the citing paper
“Remission rates were related to the magnitude of weight loss, rising progressively from 7% to 86% as weight loss for 1 year increased from <5% to >15% [121].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [121]
In the citing paper
“It should be noted, however, that the clinical benefits of weight loss are progressive, and more intensive weight loss goals (i.e., 15%) may be appropriate to maximize benefit depending on need, feasibility, and safety (106,107).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [106]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Abstract
“Between July 25, 2014, and Aug 5, 2017, we recruited 306 individuals”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
“Between July 25, 2014, and Aug 5, 2016, we recruited 306 individuals”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“End of TDR Mean (SD) 85•2 (15•0) 92•0 (17•7) -5.5 (-13•4, 2•5), p=0•1779”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
Reported -5.5 · recomputed -6.8
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Sex Male Female 4/93 (4•3%) 2/56 (3•6%) 27/83 (49•4%) 9/66 (40•9%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > References
Reported 40.9 · recomputed 13.636364
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Duration of diabetes (years) <2 ≥2, <4 ≥4, <6 6/60 (10•0%) 0/39 (0•0%) 0/50 (0•0%) 22/50 (44•0%) 24/47 (51•1%) 33/52 (42•3%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > References
Reported 42.3 · recomputed 63.461538
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“All Patients HbA1c <48mmol/mol Intervention 71/138 (48•6%)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
Reported 48.6 · recomputed 51.449275
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Results
“increased sensitivity to cold (n=51)”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Additional information
“Sensitivity to cold 57 (41•0) 37 (26•6) 12 (8•6) 8 (5•8)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“End of FR Mean (SD) 86•2 (15•4) 95•2 (17•1) -8.1 (-16•2, 0•0), p=0•0488”
§ Primary care weight-management for type 2 diabetes: the clusterrandomised Diabetes Remission Clinical Trial (DiRECT) > Imputation options:
Reported -8.1 · recomputed -9
Citations
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Cited by
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“Certain medications, such as glucocorticoids, thiazide diuretics, some HIV medications (30), and atypical antipsychotics (90), are known to increase the risk of diabetes and should be considered when deciding whether to screen.”
BackgroundDavies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing, P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018) · Diabetes Care · doi:10.2337/dci18-0033 · Cited by 3,518
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2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s002 · Cited by 3,116
“Certain medications, such as glucocorticoids, thiazide diuretics, some HIV medications (23), and atypical antipsychotics (66), are known to increase the risk of diabetes and should be considered when”
Background
Metadata
- Authors
- Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., Rodrigues, A. M., Rehackova, L., Adamson, A. J., Sniehotta, F. F., Mathers, J. C., Ross, H. M., McIlvenna, Y., Stefanetti, R., Trenell, M., Welsh, P., Kean, S., Ford, I., McConnachie, A., Sattar, N., & Taylor, R.
- Affiliations
- University of Glasgow (GB)
- Newcastle University (GB)
- Wellcome Centre for Mitochondrial Research (GB)
- Corresponding author
- Taylor, Roy
- ORCID
- Lean, Michael EJ
- Leslie, Wilma S
- Barnes, Alison C
- Brosnahan, Naomi
- Thom, George
- McCombie, Louise
- Zhyzhneuskaya, Sviatlana
- Al-Mrabeh, Ahmad
- Hollingsworth, Kieren G
- Rodrigues, Angela M
- Rehackova, Lucia
- Adamson, Ashley J
- Sniehotta, Falko F
- Mathers, John C
- Stefanetti, Renae
- Trenell, Michael
- Welsh, Paul
- Kean, Sharon
- Ford, Ian
- McConnachie, Alex
- Sattar, Naveed
- Taylor, Roy
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 391
- Issue
- 10120
- Pages
- 541-551
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2773791657
- Semantic Scholar
- 1c6fc2925c1eab869c6f9f8722d06bb35f10625b
- Cited by
- 2,095
- References
- 34
- Citations by year
- 2026: 203 · 2025: 257 · 2024: 280 · 2023: 282 · 2022: 272 · 2021: 247 · 2020: 215 · 2019: 191 · 2018: 139
- FWCI
- 118.80
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Northumbria Research Link (Northumbria University) (acceptedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- Funders
- Novo Nordisk
- Diabetes UK (13/0004691)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes remission, weight management, primary care, total diet replacement, weight loss maintenance, drug withdrawal, HbA1c, obesity, antidiabetic drugs
- MeSH terms
- Diabetes Mellitus, Type 2, Exercise Therapy, Female, Humans, Male, Middle Aged, Quality of Life, Remission Induction, Weight Loss, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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